Hand Transplantation

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Hand Transplantation

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Marco Lanzetta · Jean-Michel Dubernard (Editors) Palmina Petruzzo (Assistant Editor)

Hand

Transplantation

1 3

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Editors

MARCOLANZETTA

Director, Italian Institute of Hand Surgery Monza, Milan, Italy

Adjunct Professor, University of Canberra, Australia President, International Hand and

Composite Tissue Allograft Society JEAN-MICHELDUBERNARD

Department of Transplantation Édouard Herriot Hospital Lyon, France

Assistant Editor PALMINAPETRUZZO

Department of Surgery University of Cagliari, Italy

Library of Congress Control Number: 2006928862

ISBN-10 88-470-0373-3 Springer Milan Berlin Heidelberg New York ISBN-13 978-88-470-0373-6 Springer Milan Berlin Heidelberg New York

Springer is a part of Springer Science+Business Media springer.com

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“to my wife Mariagrazia and my sons Matteo, Michael and Pietro,

for sharing all my dreams, and

to Valter, Gianni, Domenico, heroic patients, for their trust in me and my trust in them”

Marco Lanzetta

“to my grand children Louis, Hugues, Alexis, Émilie, Céline, Elsa ...

dreams might come true”

Jean-Michel Dubernard

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The story of this book is quite simple: after the first few hand transplants, we felt the need to have regular meetings so that our clinical experiences would be beneficially shared and serve as a basis to draw some guidelines for the future. In so doing, we soon realised that a huge amount of original clinical data and information was becom- ing available as we were proceeding with our oper- ations and closely following our patients’ progress and functional outcomes. Some of these data were reported in scientific articles, but to group them in a comprehensive book seemed the best way to provide a complete review of this pioneering work.

Since starting our hand transplantation programmes, we often felt we were exploring a new area of surgery without the possibility or comfort of referring to already published work to support our own decisions. Indeed, some aspects of hand transplantation required prompt decisions based solely on personal interpretation of presenting clinical scenarios. New techniques were intro- duced to address different needs, such as the analysis of brain remodeling using functional magnetic resonance imaging or the use of a sensory glove to precondition the patient or accelerate the recovery of sensibility. Original work included creation of a specific consent form for patients, psychological tests for candidates and a comprehensive scoring system for assessing clinical out- come. There was the need to establish a grading system to evaluate acute skin rejection and clear criteria to select ideal candidates. From a legal point of view, there were no criteria for dealing with persons carrying two different sets of finger- prints. From an insurance perspective, there were

no criteria as to how the disability of these patients would be revaluated after the hand transplant.

Clinically, the most challenging issues have been identifying the best immunosuppressive drug regime and understanding how acute rejection develops and how to reverse it. Use of an addi- tional distant skin island allograft resulted in better rejection monitoring, at the same time avoid- ing the need to take multiple biopsies from the

hand. Nerve regrowth and excellent

sensibility/motor recovery was one of the most important results in hand transplantation, and leading experts in peripheral nerve regeneration suggest a scientific explanation. Rehabilitation of the transplanted hand has been very demanding for both therapists and patients, and specific pro- tocols had to be implemented.

As the hand is only one of the composite tissues currently transplanted in order to correct disabilities or deformities, we include chapters on all the other types of non-life-saving allografts, including the face, knee joint, uterus, abdominal wall and larynx.

We are honoured to have such a great number of internationally renowned personalities share their experience and knowledge in this book; their contributions have made it the most complete work available on hand and other composite tissue allografts. We hope it will serve as a useful guide for those desiring to launch their own composite tissue transplantation programmes or to those who simply wish to read about the current state of the art of this new and exciting field.

Marco Lanzetta Jean-Michel Dubernard

Preface

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1. HISTORICAL REMARKS

1a. Cosmas and Damian revisited

B.W. CONOLLY, M. BENANZIO . . . . 3 1b. Hand Transplantation as an Evolution of Microsurgery: A Logical Step Towards Better

Reconstructive Options

M. LANZETTA . . . . 11

2. EXPERIMENTAL LIMB TRANSPLANTATION

2a. Hind-Limb Transplantation in the Rat: Surgical Technique, Anaesthesia and Early Postoperative Management

M. MOLITOR, T. KANATANI, M. LANZETTA . . . . 27 2b. Indefinite Survival and Functional Recovery of Limb Allografts in Rodents

T. KANATANI, M. LANZETTA, G.A. BISHOP . . . . 41 2c. Induction of High-Level Chimerism in Composite Tissue Transplants

K. MURAMATSU, K. DOI, H. TANAKA, T. TAGUCHI . . . . 47 2d. Simultaneous Vascularised Bone Marrow Transplantation to Promote Acceptance of Limb Allografts M. LANZETTA, A. KUBITSKIY, G.A. BISHOP, J. LI, G.W. MCCAUGHAN . . . . 57 2e. Experimental Approaches to Composite Tissue Allograft Transplants

M. SIEMIONOW, Y. KULAHCI . . . . 61 2f. A Review of Current Strategies to Achieve Tolerance in Animal Models

D. ZAMFIRESCU, I. LASCAR . . . . 79 2g. The History of Experimental Hand Transplantation in Primates

R.K. DANIEL, K.A. BRENNER . . . . 89 2h. Hand Transplantation in Monkeys: Technical Details and Immunological Aspects

S.E.R. HOVIUS, H.M. ZUIJDENDORP, J.J.P.D. STEVENS . . . . 95

4a. Selection of Candidates and Waiting List, Dealing with the Media and the Public, Setting Up a Pilot Study, Clinical Trial Organization, Staff Requisites for Hand Transplantation: The Lyon Experience J.M. DÛBERNARD, X. MÂRTIN, P. PÊTRUZZO . . . . 133 4b. Selection of Candidates and Waiting List, Dealing with the Media and the Public, Setting Up a Pilot Study, Clinical Trial Organization, Staff Requisites for Hand Transplantation: The Milan Experience M. LÂNZETTA, R. NÔLLI, I. RÂDAELLI, R. CÔLETTI, F. PÂLEARI, A. CÂPPELLINI, F. U^GGERI,

M. S^CALAMOGNA, A. RÂMPA . . . . 137 4c. Selection of Candidates and Waiting List, Dealing with the Media and the Public, Setting Up a Pilot Study, Clinical Trial Organization, Staff Requisites for Hand Transplantation: The Innsbruck Experience G. B^RANDACHER, S. SCHNEEBERGER, R. MÂRGREITER . . . . 149 4d. Selection of Candidates and Waiting List, Dealing with the Media and the Public, Setting Up a Pilot Study, Clinical Trial Organization, Staff Requisites for Hand Transplantation: The Brussels Experience F. S^CHUIND, C. VÂNHÔLDER, D. A^BRAMOWICZ . . . . 157 4e. Patient Management and Follow-Up

P. PÊTRUZZO, S. LÛCCHINA, C. DÊZZA, G. LÛCCHINI . . . . 167

5. SURGICAL TECHNIQUE OF HAND TRANSPLANTATION

5a. Instruments, Sutures and Needles for Hand Transplantation

G. LUCCHINI, F. MAGNI, M. LANZETTA . . . . 173 5b. Anaesthetic Management

G. VITALE, E. MARTINEZ, P. MAISANO, L. DEMARCHI, M. SAINI, G. BELLANI . . . . 179 5c. Harvesting the Hand

M. LANZETTA, R. NOLLI, L. BETTELLA . . . . 187 5d. Preparing the Recipient

A. GAZARIAN . . . . 191

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5e. Technical and Surgical Details of Hand Transplantation

M. N^INKOVIC . . . . 197 5f. Hand Replantation and Transplantation: More Differences than Similarities

M. L^ANZETTA, R. N^OLLI . . . . 205

6. IMMUNOLOGY OF HAND TRANSPLANTATION

Current Concepts

O. THAUNAT, E. MORELON . . . . 209

7. IMMUNOSUPPRESSIVE THERAPY

7a. Induction and Maintenance Therapy

P. PETRUZZO . . . . 217 7b. Side-Effects and Potential Complications

L. BADET, P. PETRUZZO, N. LEFRANÇOIS, E. MORELON, X. MARTIN, J.M. DUBERNARD . . . . 223 7c. CMV Infection and Reactivation

S. SCHNEEBERGER, R. MARGREITER, S. LUCCHINA, M. LANZETTA, H. BONATTI . . . . 227 7d. Specific T-Cell Response to HCMV Infection

G. LUCCHINI, P. PIOLTELLI, M. LANZETTA . . . . 237 7e. Ocular Complications after Hand Transplantation

D. VERITTI, P. LANZETTA . . . . 241

8. LIMB REJECTION AND MONITORING

8a. Skin Rejection in Human Hand Allografts: Histological Findings and Grading System

J. KANITAKIS . . . . 249 8b. Pharmacological Treatment of Rejection

P. PETRUZZO . . . . 259 8c. Monitoring Rejection with a Distant Sentinel Skin Graft

M. LANZETTA, L. ROVATI . . . . 263

9. FUNCTIONAL RECOVERY OF TRANSPLANTED HANDS

9a. Bone Healing in Hand Transplantation

M. GABL, S. PECHLANER, M. LUTZ, R. ARORA, M. BLAUTH, M. RIEGER, M. NINKOVIC, H. PIZA,

S. SCHNEEBERGER, R. MARGREITER . . . . 271 9b. Return of Sensibility and Motor Recovery of Extrinsic and Intrinsic Muscles

G. URSO, L. STROPPA, T. BARCHITTA, P. COSSA . . . . 279 Contents XI

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9c. From Silent Neuroma to Reactivation of Axonal Growth: How a Peripheral Nerve can Start to Regenerate into a Transplanted Hand?

L.B. DAHLIN, G. LUNDBORG . . . . 291 9d. Modified Visual Feedback in Rehabilitation

H. PARMENTIER . . . . 303 9e. Analysis of Motor Unit Reinnervation in Muscles of the Transplanted Hand

M. POZZO, D. FARINA . . . . 307 9f. Role of the Sympathetic Nervous System on Arterial Distensibility

C. GIANNATTASIO . . . . 317 9g. An Instrumental Kit for a Comprehensive Assessment of Functional Recovery

V. MACELLARI, S. MORELLI, C. GIACOMOZZI, G. DEANGELIS, G. MACCIONI, M. PAOLIZZI, D. GIANSANTI . . . . 327 9h. Human Brain Plasticity after Bilateral Hand Allograft

A. ABALLÉA, P. GIRAUX, M. SCHIEBER, J.M. DUBERNARD, A. SIRIGU . . . . 341 9i. The Sensor Glove in Preoperative Conditioning and Postoperative Rehabilitation

G. LUNDBORG, B. ROSÉN . . . . 347 9j. A Comprehensive Functional Score System in Hand Transplantation

M. LANZETTA, P. PETRUZZO . . . . 355 9k. Quality of Life in Hand Transplant Patients

D. BACHMANN . . . . 363

10. PSYCHOLOGICAL ISSUES IN HAND TRANSPLANTATION

10a. Psychological Evaluation and Patient’s Profile

I. CARTA, O. CONVERTINO, J. BAGNASCO, S. FORNARA . . . . 369 10b. Hand Transplant and Body Image

G. BURLOUX . . . . 375 10c. Psychological Effects of Hand Transplantation

I. CARTA, O. CONVERTINO, J. BAGNASCO, S. FORNARA . . . . 381

11. OTHER COMPOSITE TISSUE TRANSPLANT

11a. Allogeneic Vascularised Knee Transplantation

G. H^OFMANN . . . . 391 11b. Laryngeal Transplantation

R.R. L^ORENZ, M. S^TROME . . . . 399 11c. Uterus Transplantation

W. F^AGEEH, G. L^UCCHINI . . . . 409

XII Contents

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11d. Abdominal Wall Transplantation: A Review of the Literature

G. LUCCHINI, M. LANZETTA . . . . 421 11e. First Human Face Allograft: Report at 4 Months

J.M. DUBERNARD, B. DEVAUCHELLE . . . . 425 11f. Lower-Extremity Hindquarter Transplantation in Conjoined Twins

R.M. ZUKER . . . . 435

12. FUTURE DIRECTIONS

12a. Limb Transplantation in Congenital Deformities

A. GAZARIAN, D.O. ABRAHAMYAN . . . . 445 12b. Mechanisms Involved in the Induction of Tolerance in Allogeneic Hand Tranplantation: A Proposal A. ELJAAFARI, P. PETRUZZO, X. MARTIN, J.M. DUBERNARD . . . . 453 12c. Induction of Tolerance in Allotransplantation

M. NORIS, G. REMUZZI . . . . 461

13. THE INTERNATIONAL REGISTRY ON HAND AND COMPOSITE TISSUE TRANSPLANTATION (IRHCTT)

The International Registry on Hand and Composite Tissue Transplantation (IRHCTT)

M. LANZETTA, P. PETRUZZO, R. MARGREITER, J.M. DUBERNARD, F. SCHUIND, W.C. BREIDENBACH, G. LUCCHINI,

S. SCHNEEBERGER, C. VANHOLDER, D. GRANGER, G. PEI, J. ZHAO, X. ZHANG . . . . 477

14. AN EXTENSIVE BIBLIOGRAPHY ON HAND TRANSPLANTATION

An Extensive Bibliography on Hand Transplantation

G. LUCCHINI . . . . 485

SUBJECTINDEX . . . . 491

15. VIDEO-CLIPS OF HAND TRANSPLANTATION (DVD)

Video-Clips of Hand Transplantation (DVD) M.LANZETTA, J.M. DUBERNARD, F. SCHUIND

Contents XIII

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Aballéa Antoine

Cognitive Science Institute CNRS UMR

Bron, France

Abrahamyan Davit O.

Clinique du Parc Lyon, France Abramowicz Daniel Department of Nephrology Erasme University Hospital

Medical School of the Université libre de Bruxelles Bruxelles, Belgium

Arora Rohit

Department of Traumatology The Medical University Innsbruck, Austria Bachmann Danièle Department of Psychiatry Édouard Herriot Hospital Lyon, France

Bagnasco Juliette

Department of Psychiatry San Gerardo Hospital University of Milan-Bicocca Monza, Milan, Italy

Barchitta Tatiana KIROS

Hand Therapy Center Rome, Italy

Bellani Giacomo

Department of Anaesthesia and Critical Care San Gerardo Hospital

Monza, Milan, Italy

Benanzio Mario (deceased) Orthopaedic Surgeon and Medico-Legal Consultant Sydney, Australia Bettella Lorenzo Former Clinical Fellow

Hand Surgery and Microsurgery Unit San Gerardo Hospital

Monza, Milan, Italy Bishop G. Alex

Collaborative Transplant Laboratory Sydney University

Sydney, Australia Blauth Michael

Department of Traumatology The Medical University Innsbruck, Austria Bonatti Hugo

Department of General and Transplant Surgery Innsbruck Medical University

Innsbruck, Austria Brandacher Gerald

Department of General and Transplant Surgery The Medical University

Innsbruck, Austria Breidenbach Warren C.

Kleinert Kutz Hand Care Center Louisville, KY, USA

Brenner Kevin A.

Unit of Plastic Surgery University of California Irvine, KY, USA

Contributors

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XVI Contributors

Burloux Gabriel Former Consultant Department of Psychiatry Édouard Herriot Hospital Lyon, France

Cappellini Anna Histopathology Unit San Gerardo Hospital Monza, Milan, Italy Carta Italo

Coletti Rosella

Italian Institute of Hand Surgery Monza, Milan, Italy

Conolly Bruce W.

Hand Surgery Unit

Sydney and St. Luke's Hospitals University of Sydney

Sydney, Australia Convertino Ornella Department of Psychiatry San Gerardo Hospital University of Milan-Bicocca Monza, Milan, Italy

Cossa Paola Hand Therapy Unit San Gerardo Hospital Monza, Milan, Italy Cozzoli Mauro

Pontifical Lateran University Rome, Italy

Dahlin Lars B.

Department of Hand Surgery Malmö University Hospital Malmö, Sweden

Daniel Rollin K.

Plastic Surgery Unit University of California Irvine, USA

De Angelis Giorgio

Department of Technology and Health Istituto Superiore di Sanità

Rome, Italy

De Marchi Lorenzo Former Clinical Fellow

Monza, Milan, Italy Devauchelle Bernard Maxillofacial Unit Nord Hospital CHU Amiens, France Dezza Clara

Former Clinical Fellow

Monza, Milan, Italy Doi Kazuteru

Department of Orthopaedic Surgery Ogori Daiichi General Hospital Yamaguchi, Japan

Dubernard Jean-Michel Department of Transplantation Édouard Herriot Hospital Lyon, France

Eljaafari Assia

Mixed Unit of Immunogenomics, BioMerieux/HCL and Unit of Transplantation Surgery Department of Dermatology Édouard Herriot Hospital Lyon, France

Fageeh Wafa

King Abdul Aziz University Uterine Transplant Team Jeddah, Saudi Arabia

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Contributors XVII

Farina Dario

Center for Sensory-Motor Interaction (SMI) Faculty of Engineering and Science

Department of Health Science and Technology Aalborg University

Aalborg, Denmark Fornara Serenella

Gabl Markus

Department of Traumatology Medical University

Innsbruck, Austria Gazarian Aram Clinique du Parc Lyon, France Genovese Umberto

Institute of Forensic Medicine and Insurance University of Milan

Milan, Italy

Giacomozzi Claudia

Rome, Italy

Giannattasio Cristina

Department of Internal Medicine Milano-Bicocca University and San Gerardo Hospital

Monza, Milan, Italy Giansanti Daniele

Rome, Italy Giraux Pascal

Bron, France

Granger Darla

Department of Surgery University of Louisville Louisville, KY, USA Hofmann Gunther

Department of Traumatology and Reconstructive Surgery

Friedrich Schiller University Jena, Germany

Department of Traumatology and Reconstructive Surgery

BG Kliniken Bergmannstrost Halle, Germany

Hovius Steven E.R.

Department of Plastic and Reconstructive Hand Surgery

Erasmus University Medical Center Rotterdam Rotterdam, The Netherlands Kanatani Takako

Former Fellow

The Microsearch Foundation of Australia Sydney, Australia

Rosai Hospital

Department of Orthopaedics Kobe, Japan

Kanitakis Jean

Department of Dermatology Édouard Herriot Hospital Lyon, France

Kubitskiy Alexander

Microsearch Foundation of Australia Sydney, Australia

AW Morrow Laboratory and Collaborative Transplantation Group Sydney University

Sydney, Australia Kulahci Yalcin

Department of Plastic Surgery The Cleveland Clinic Foundation Cleveland, Ohio, USA

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XVIII Contributors

Lanzetta Marco

Director, Italian Institute of Hand Surgery Monza, Milan, Italy

Former Director, Hand Surgery and Reconstructive Microsurgery Unit

San Gerardo Hospital Monza, Milan, Italy

Former Associate Professor of Orthopaedics University of Milan-Bicocca

Milan, Italy

Adjunct Professor of Orthopaedics and Microsurgery

University of Canberra, Australia

President, International Hand and Composite Tissue Allograft Society

Lanzetta Paolo

Department of Ophthalmology University of Udine

Udine, Italy Lascar Ioan

“Carol Davila” Bucharest Medical University Clinic of Plastic Surgery and

Reconstructive Microsurgery Bucharest Emergency Hospital Bucharest, Romania

Li Jian

Sydney, Australia Lorenz Robert R.

Section of Head and Neck Surgery Cleveland Clinic Lerner College of Medicine

Case Western Reserve University The Cleveland Clinic Foundation Cleveland, Ohio, USA

Lucchina Stefano Former Clinical Fellow

Monza, Milan, Italy

Lucchini Giovanna Former Clinical Fellow

Monza, Milan, Italy Lundborg Göran

Lutz Martin

Department of Traumatology The Medical University Innsbruck, Austria Maccioni Giovanni

Rome, Italy Macellari Velio

Rome, Italy Magni Francesca

Maisano Paolo

Monza, Milan, Italy Margreiter Raimund

Department of Transplant Surgery The Medical University

Innsbruck, Austria Martin Xavier

Martinez Ettore

Monza, Milan, Italy

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Contributors XIX

McCaughan Geoffrey W.

Sydney, Australia Menna Giuseppina Territorial Forensic

Science Laboratory of Lombardia Milan, Italy

Molitor Martin

Department of Plastic and Aesthetic Surgery University Hospital

Olomouc, Czech Republic Morelli Sandra

Rome, Italy

Morelon Emmanuel

Department of Immunology and Renal Transplantation

Édouard Herriot Hospital Claude Bernard Lyon 1 University Lyon, France

Muramatsu Keiichi

Department of Orthopaedic Surgery Yamaguchi University

School of Medicine Ube, Yamaguchi, Japan Ninkovic Marina

Physical Medicine and Rehabilitation Unit The Medical University

Innsbruck, Austria Ninkovic Milomir

Department of Plastic, Reconstructive and Hand Surgery

Burn Centre

Hospital Bogenhausen

Technical University of Munich Munich, Germany

Nolli Roberta

Noris Marina

Department of Medicine and Transplantation Bergamo Hospital

Mario Negri Institute for Pharmacological Research Bergamo, Italy

Paleari Felice Diabetology Unit San Gerardo Hospital Monza, Milan, Italy Paolizzi Mariano

Rome, Italy Parmentier Hélène

Department of Orthopaedics of the Upper Limbs Édouard Herriot Hospital

Lyon, France Pechlaner Sigurd

Department of Traumatology The Medical University Innsbruck, Austria Pei Guoxian

Department of Orthopaedic and Traumatology Nanfang Hospital

The First Military Medical Unversity Guangzhou, P. R. China

Petruzzo Palmina

Department of Surgery University of Cagliari, Italy Pioltelli Pietro

Haematology Unit San Gerardo Hospital Monza, Milan, Italy Piza Hildegunde

Department of Plastic and Reconstructive Surgery The Medical University Innsbruck, Austria

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XX Contributors

Pozzo Marco

Department of Physiology and Pharmacology Section for Muscle and Exercise Physiology Karolinska Institute

Stockholm, Sweden Radaelli Ilaria

Rampa Alessandro

Former Health Services Manager San Gerardo Hospital

Monza, Milan, Italy Remuzzi Giuseppe

Department of Medicine and Transplantation and Transplant Research Center

Bergamo Hospital

Mario Negri Institute for Pharmacological Research Bergamo, Italy

Rieger Michael

Department of Radiology The Medical University Innsbruck, Austria Rosén Birgitta

Rovati Luca Plastic Surgery Unit San Gerardo Hospital Monza, Milan, Italy Saini Maurizio

Monza, Milan, Italy Scalamogna Mario North Italian Transplant Milan, Italy

Scarpis Paolo Police Chief Milan, Italy

Schieber Marc

Department of Neurology University of Rochester Rochester, USA Schneeberger Stefan

Department of General and Transplant Surgery Medical University

Innsbruck, Austria Schuind Frédéric

Department of Orthopaedics and Traumatology Erasme University Hospital

Medical School of the Université libre de Bruxelles Bruxelles, Belgium

Sicard Didier

Department of Internal Medicine University of Paris

Cochin Hospital Paris, France Siemionow Maria

Department of Plastic Surgery The Cleveland Clinic Foundation Cleveland, Ohio, USA

Sirigu Angela

Bron, France Stevens Jeroen J.P.D.

Erasmus University Medical Center Rotterdam Rotterdam, The Netherlands

Strome Marshall

The Head and Neck Institute

Cleveland Clinic Lerner College of Medicine Case Western Reserve University

The Cleveland Clinic Foundation Cleveland, Ohio, USA

Stroppa Luisa Hand Therapy Unit San Gerardo Hospital Monza, Milan, Italy

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Contributors XXI

Taguchi Toshihiko

Department of Orthopaedic Surgery School of Medicine

Yamaguchi University Yamaguchi, Japan Tanaka Hiroshi

Department of Orthopaedic Surgery School of Medicine

Yamaguchi University Yamaguchi, Japan Thaunat Olivier

National Institute of Health and Medical Research Institute for Biomedical Research "Les Cordeliers"

Pierre and Marie Curie University Paris, France

Uggeri Franco

Department of Surgery San Gerardo Hospital University of Milan-Bicocca Milan, Italy

Urso Graziella

The “Carrobiolo” Rehabilitation Centre Monza, Milan, Italy

Van Holder Carlo

Department of Plastic Surgery OLV Lourdes Ziekenhuis Waregem, Belgium Veritti Daniele

Department of Ophthalmology University of Udine

Udine, Italy

Vitale Giovanni

Monza, Milan, Italy Zamfirescu Dragos

“Carol Davila” Bucharest Medical University Clinic of Plastic Surgery and

Reconstructive Microsurgery Bucharest Emergency Hospital Bucharest, Romania

Zhang Xinying

Department of Orthopaedics The First Affiliated Hospital of Harbin Medical University Harbin, P.R. China

Zhao Jinmin

Department of Orthopaedic Trauma and Hand Surgery

The First Affiliated Hospital of Guangxi University Guangxi, P.R. China Zuijdendorp H. Mischa

Erasmus University Medical Center Rotterdam Rotterdam, The Netherlands

Zuker Ronald M.

Division of Plastic Surgery The Hospital for Sick Children Toronto, Ontario

Canada